Alcohol Related Disease

Question 1

What is the difference between steatosis and steatohepatitis?

Answer 1

Steatosis is fatty liver

Steatohepatitis is fatty liver with inflammation

Question 2

What questions that need to be asked in history are covered in the CAGE mnemonic?

Answer 2

Have you ever felt the need to Cut down?
Have you been Annoyed by criticism of your drinking?
Have you felt Guilty about your drinking?
Do you need an Eyeopener?

Question 3

What score on a FAST questionnaire is considered to be FAST positive?

Answer 3

A total score of 3 or more

Question 4

When should an AUDIT score be obtained?

Answer 4

When the patient is deemed FAST positive

Question 5

What scores on an AUDIT test correspond to increasing risk, higher risk and possible dependence?

Answer 5

Increasing risk- 8-15
Higher risk- 16-19
Possible dependence- 20+

Question 6

What are some common signs of chronic liver disease?

Answer 6

Spider naevi
Palmar erythema 
Gynaecomastia
Loss of axillary and pubic hair 
Ascites 
Encephalopathy

Question 7

What lab tests are indicative of alcohol related liver disease?

Answer 7

Aspartate amino transferase (AAT) > alanine amino transferase (ALT) ratio >2
Raised gamma glutamyl transferase
Macrocytosis
Thrombocytopenia (low platelets)

Question 8

How is hepatic encephalopathy graded?

Answer 8

Graded 1-4
1 corresponds to mild confusion
4 corresponds to coma

Question 9

What are the causes of hepatic encephalopathy?

Answer 9

Infection 
Drugs 
Constipation 
GI bleed
Electrolyte disturbance

Question 10

What interventions should be made in cases of hepatic encephalopathy?

Answer 10

Bowel clear out- lactulose or enema
Antibiotics
Supportive- ITU airway support, NG tubes for meds

Question 11

What are the symptoms of bacterial peritonitis?

Answer 11

Abdominal pain 
Fever 
Rigors 
Renal impairment 
Tachycardia 
Temperature

Question 12

What test should be done in suspected cases of spontaneous bacterial peritonitis?

Answer 12

An ascitic tap looking for:
Fluid protein and glucose levels
White cell content

And to grow cultures

Question 13

What neutrophil count and protein levels are indicative of spontaneous bacterial peritonitis?

Answer 13

Neutrophil count >0.25x10^9/L

Protein <25g/L

Question 14

What interventions should be made in cases of spontaneous bacterial peritonitis?

Answer 14

IV antibiotics
Ascitic fluid drainage
IV albumin infusion (20% ALBA)

Question 15

How would alcoholic hepatitis usually present?

Answer 15

Jaundice
Encephalopathy
Infections common
Decompensated hepatic function (low albumin and raised prothrombin time)

Question 16

How is alcoholic hepatitis diagnosed?

Answer 16

Raised bilirubin
Raised GGT and AlkP
Alcohol history
Exclude other causes

Question 17

What is the mortality rate of alcoholic hepatitis?

Answer 17

40%

In severe cases up to 90%

Question 18

What interventions should be made in cases of alcoholic hepatitis?

Answer 18

Treat infection 
Treat encephalopathy 
Treat alcohol withdrawal 
Protect against GI bleeding 
Airway protection/ITU care

Question 19

When should steroids be given for alcoholic hepatitis?

Answer 19

When a Glasgow alcoholic hepatitis score >9 is present

Question 20

What are the causes of fatty liver?

Answer 20

Obesity
Diabetes
Hypercholesterolaemia
Alcohol

Question 21

What fraction of those with steatohepatitis develop cirrhosis?

Answer 21

1/4

Question 22

What is the treatment for steatohepatitis?

Answer 22

Weight loss and exercise